POS0646 RISK FACTORS FOR POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH RHEUMATIC DISEASES
Authors: D. A. Herrera Van Oostdam, N. García-Mosqueda, C. Abud-Mendoza
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Some patients with rheumatic diseases (RD) can require major surgical intervention. There are several risk factors for perioperative complications that must be addressed during de preoperative process <sup>[1,2]</sup>. <h3>Objectives</h3> identify associated factors related to postoperative complications in patients with RD. <h3>Methods</h3> We performed a cohort study of patients with RD that required an elective or an emergency surgery from 2019-2021. We used as controls, patients with No-Rheumatic Diseases (NRD). All patients had preoperative assessment using Lee surgery index and the American College of Surgeons National Quality Improvement Program score (NSQIP), and we estimated disease activity of all RD according to the disease-specific activity scores. We follow-up patients until hospital discharge or death. Univariate and multivariate models were used to determine risk factors for postoperative complications (composite outcome: cardiac or lung complications, blood transfusion, infection, surgery reintervention, respiratory failure, use of vasopressors). <h3>Results</h3> We included 299 patients, 53 patients with RD and 246 NRD. The median age was 49 years in RD. Most patients with RD were women (85%). At baseline NRD patients had higher serum glucose levels, more use of insulin, and had higher rate of acute kidney injury. In the RD-group, 26 had rheumatoid arthritis, 13 systemic lupus erythematosus and 9 others (spondylitis, autoimmune hepatitis, antiphospholipid syndrome, polyarteritis nodosa). Active rheumatic disease was present in 21 patients. Most of the patients with RD (54%) had moderate to high risk of any complication, pneumonia, and risk of wound infection according the NSQIP score. The postoperative complications were higher in RD 37% vs NRD 16% (p=0.0003). Infection developed in 17% of RD patients vs 2.4% of NRD (p &lt; 0.0001), uncontrolled hypertension was present in 3% in RD vs 0.4% in NRD, while hypovolemic shock was more frequent in NRD 4% vs 0%. One patient with RD died. Of the patients with RD, 58% continued with in-hospital glucocorticoid and 22% with another non-glucocorticoid immunosuppressor in-hospital. In the logistic regression analysis, the presence of active RD at the time of surgery (OR 4.9, IC95% 1.4-18) acute preoperative kidney injury (OR 3, IC95% 1.2-7.3) were predictors of post operative complications; type of surgery performed (elective or urgent), and in-hospital use of glucocorticoid, and immunosuppressors were not significant. <h3>Conclusion</h3> We observed higher post operative complications in RD patient's vs controls. The main prognostic factors were active rheumatic disease, preoperative kidney injury, while the type of surgery performed and in-hospital glucocorticoid or immunosuppressors were not associated to post operative complications. <h3>References</h3> [1]Goodman SM, et al. 2022 ACR/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. Arthritis Care Res (Hoboken). 2022 Sep;74(9):1399-1408. [2]Franco AS, Luamoto LR, Pereira RM. Perioperative management of drugs commonly used in patients with rheumatic diseases: a review. Clinics.2017;72(6):386-390. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.